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Priority PassTM enrollment form for the Supplementary American Express® Platinum Cardmember

SUPPLEMENTARY PLATINUM CARDMEMBER PERSONAL DETAILS
(Valid for only one Supplementary Cardmember per Basic Cardmember)

Card Expiry Date:

I instruct Priority Pass Ltd. to charge lounge usage fees to access the lounges in India and for my accompanying guests in India and abroad, when received, at the prevailing rate (currently US$ 32 per person, per visit) to my American Express Platinum Card. Renewal terms and conditions are at the discretion of Priority Pass Ltd. I agree to abide by the conditions of use as contained in the lounge directory.

I agree that American Express® may transmit to Priority Pass information necessary for the creation, dispatch and operation of the Priority Pass Card. This information will be what you have already provided to American Express as part of your application for an American Express Card.

Terms and Conditions

This offer is open to all American Express Platinum Cardmembers ("Cardmembers") billed in Indian Rupees, whose Accounts are valid and in good standing • Cardmembers are not bound in any way to participate in this offer • Any such participation is voluntary and the offer is being made purely on a best effort' basis • Supplementary Cardmembers accompanied by guest(s) will have to pay a Lounge Visit Fee of US$ 32 per guest per visit, which would automatically be charged to their American Express Platinum Card • These terms have to be read along with the Conditions of Use mentioned overleaf• Any disputes arising out of this programme shall be subject to the exclusive jurisdiction of the courts in the state of Delhi. • Complimentary visits to lounges will not be applicable with the Priority Pass lounges within India, the Cardmember may be charged a Lounge Visit Fee of US$ 32 per person per visit, which would automatically be charged to their American Express Platinum Card.

Conditions of Use